Breast-Conserving Surgery in Bilateral Breast Cancer

Abstract

Background Bilateral breast cancer (BBC) may present as synchronous(SBC) or metachronous breast cancer(MBC). Optimal surgical management of BBC patients is not well defined. Here we report on histopathology, treatment, and outcomes in BBC patients. Methods Upon IRB approval, we identified BBC patients diagnosed and treated for invasive breast cancer between 1999–2007. Retrospective chart review for demographics, histopathology, treatment, and outcomes was performed. Factors associated with BCS choice were collected. Contraindication to BCS was defined as any of the following one-breast findings: multicentric disease; tumor considered too large for BCS; patient without a nominal breast size for acceptable cosmetic results. McNemar's test for matched pairs(binary variables) or the paired t-test(continuous variables) was used to examine if a pathologic characteristic differed within a cancer pair. Kaplan-Meier methods estimated overall survival(OS). Results 203 BBC patients(119 SBC,84 MBC) comprised our study group. Histopathologic characteristics of the first and second cancers diagnosed in both the SBC and MBC patients were very similar in histologic type and in molecular profiles. 57% of MBC patients underwent breast-conserving surgery at initial diagnosis versus 34% of patients with SBC. BCS contraindications were similar in both groups: 16(34%) of MBC and 28(36%) of SBC patients. Kaplan-Meier OS estimates at 5yrs/10yrs were 86%/78% for MBC, and 87%/77% for SBC patients, respectively. Conclusions OS was excellent for both MBC and SBC groups. Contraindications to breast-conserving surgery did not differ between groups. However, patients with SBC were less likely to undergo BCS compared to patients with MBC at time of initial diagnosis.

The prognostic comparison among unilateral, bilateral, synchronous bilateral, and metachronous bilateral breast cancer: A meta‐analysis of studies from recent decade (2008‐2018)

“…Among the 15 included studies, five studies were from Europe, two from North America, five from Asia, one from Africa, and two from Australia . The sample size of included studies ranged from 110 to 34 557 and totally 75 214 participants were enrolled, including 72 302 UBC and 2912 BBC (1842 SBBC, 946 MBBC and 124 BBC with unknown interval).…”

“…These studies were divided into three groups based on the interval time to differentiate SBBC from MBBC (3, 6 and 12 months). The study from O'Brien et al used both 3 and 6 months as interval cut‐off (SBBC ≤ 3 months while MBBC > 6 months, Table ), hence it was included in the meta‐analysis of both groups (Figure A,B). Three studies used 3 months as the interval, the summary HR of SBBC vs MBBC was 0.64 (95% CI = 0.44‐0.94) without heterogeneity (I 2 = 58%, P = 0.09) (Table , Figure A,D).…”

“…The study from O'Brien et al used both 3 and 6 months as interval cut‐off (SBBC ≤ 3 months while MBBC > 6 months, Table ), hence it was included in the meta‐analysis of both groups (Figure A,B). Three studies used 3 months as the interval, the summary HR of SBBC vs MBBC was 0.64 (95% CI = 0.44‐0.94) without heterogeneity (I 2 = 58%, P = 0.09) (Table , Figure A,D). Four studies adopted 6‐month as the interval time, and the summary HR was 1.17 (95% CI = 0.84‐1.63) without heterogeneity (I 2 = 56%, P = 0.10) (Table , Figure B,E).…”

“…Three studies used 3 months as the interval, the summary HR of SBBC vs MBBC was 0.64 (95% CI = 0.44‐0.94) without heterogeneity (I 2 = 58%, P = 0.09) (Table , Figure A,D). Four studies adopted 6‐month as the interval time, and the summary HR was 1.17 (95% CI = 0.84‐1.63) without heterogeneity (I 2 = 56%, P = 0.10) (Table , Figure B,E). Twelve months was chosen as interval in the other four studies, and the summary HR was 1.45 (95% CI = 1.10‐1.92) without heterogeneity (I 2 = 0%, P = 0.51) (Table , Figure C,F).…”

Prognostic Factors for Metachronous Contralateral Breast Cancer: Implications for Management of the Contralateral Breast

“…In a prospective survey study, Shelby et al reported that young breast cancer survivors were less likely to undergo repeated mammograms (22). In a retrospective chart review, O'Brien et al found that although overall survival was similar in metachronous (MBC) and synchronous breast cancer, patients in the MBC group with discordant ER receptor status and an overall worse prognosis (23). In our study, we found that young patients were also more likely to develop a node-positive mCBC.…”